noted with children who are at level IV and V on the GMFCS. Drooling is often treated with botulinum toxin A, benztropine or anticholinergics (e.g. glycopyrrolate). A review on the treatment of sialorrhea in children with cerebral palsy found that it was not possible to tell whether these interventions worked or were safe. Anticholinergics may contribute to constipation. Bisphosphonates are used to treat osteoporosis in adults. Osteoporosis is common in children with cerebral palsy, and non-oral bisphosphonates have been used to treat children with a very low bone mass density and a medical history of fragility fracture. Oral baclofen or diazepam is used to reduce spasticity which results in pain, muscle spasms or functional disability. Baclofen is used for a long-term effect and works at the spinal level. Diazepam is fast-acting. Baclofen may also be administerd intrathecally. Trihexyphenidyl is often prescribed for dystonia. However, a 2018 Cochrane review (one study met inclusion criteria) on the use of Trihexyphenidyl for dystonia found insufficient evidence of its effectiveness. Sometimes, medication used to manage physical aspects of CP can have effects on the person's mental health, or medications used to manage mental health can affect motor function. Orthopaedic surgery Deformities in cerebral palsy children are inherently known for being Multiplane i.e. occurring in more than one plane such as transverse plane through which rotation occurs and sagittal plane through which flexion/extension of joint occurs. Furthermore, deformities in cerebral palsy children are characteristically multilevel i.e. occurring at simultaneously at more than one joint. This adds to the complexity of orthopedic management of cerebral palsy children. Thus, multilevel orthopedic surgery is the mainstay of orthopedic management. Multilevel orthopedic surgery may include soft tissue as tendon lengthening or transfer and/or bony surgery as corrective bone osteotomies. Multilevel orthopedic surgery is usually performed in one anesthetic sitting. This allows for the institution of one postoperative rehabilitation protocol and reduces hospital admission rates. Orthopaedic surgery is widely used to correct fixed deformities and improve the functional capacity and gait pattern of children with CP. Dynamic deformities such as ankle equinus and hip adduction deformity leading to subluxation are usually managed conservatively with exercises; serial casting and botulinum toxin type A injections. This main goal of these conservative measures is to impede or prevent the happening of fixed or static joint deformities. Once joint contractures- fixed deformities - develop or joint subluxation or dislocation occurs, surgical treatment could become